Opiate Use and Abuse

Opiate History The first written mention of opiates is believed to have come from third-century B. C. Greek culture and the writings of philosopher Theopphrastus. By this time, people had discovered that drying the poppy plant’s extracted fluid created a highly powerful drug which would become known as opium. The first opiates are believed to have been cultivated during the Neolithic period in what is now known as Switzerland. The settlements in this area cultivated Papaver which was a source of poppy seeds.

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Many historians agree that these early individuals discovered the narcotic effect of the poppy plant and therefore were the first users of opiates (Rosen, 2009). Opiate analgesics have been used by humans for thousands of years and are the longest continuously used class of medications (Lanier, 2009). What is an Opiate? Opiates, or narcotics, are a group of drugs most often used for moderate to severe pain relief. Opiates are the drugs derived from opium and its ingredients, such as morphine and codeine, and opioids are synthetic imitations of these types of drugs.

The term opioid also refers to naturally occurring substances in the body, such as endorphins and enkephalins, which act on the brain to decrease pain sensations (Ling, 1990). Frequently abused prescription pain medications include hydrocodone (Lorcet, Lortab, Vicodin), oxycodone (OxyContin, Percocet, Percodan), codeine (Tylenol 2s, 3s, and 4s), fentanyl (Duragesic), and morphine (MS Contin). These drugs are commonly prescribed for acute pain (for example, tooth, post-injury, or surgery pain) or chronic pain (for example, back pain or pain associated with malignancy)(Byrne, 2009). What is Opiate Addiction?

Opiate addiction is recognized as a central nervous system disorder, caused by regular intake of any of these opioid-based drugs. When these drugs are taken, your body’s pleasure pathway is triggered, creating a euphoric “high” that many become psychologically addicted to almost immediately. After prolonged use, the nerve cells in the brain, which would otherwise produce endogenous opiates (natural painkillers, or endorphins), cease to function normally. The body stops producing endorphins because it is receiving opiates instead. Some opiates create over 100 times more endorphins than the body would naturally.

Imagine the impact this has on the brain and relevant nerve cells. When the brain shuts down endorphin production because of opiate use, the addictive nature becomes clear and there is no other way to compensate for the lost endorphins except to take more and more of the opiate in question. This is the vicious cycle of opiate addiction. The degeneration of these nerve cells causes a physical dependency to an external supply of opiates. Over time, a physical dependence upon the drug develops with regular use. This is opiate addiction. Side Effects of Opiate Use Some side effects with opiate use, such as constipation, are well known.

Others are more difficult to gauge because it’s often hard to study those who are on heroin or take opiates chronically for pain management. When used as prescribed, opiates can still cause side effects, but the more serious ones are usually reported with misuse and overdose. Side effects can include sedation, euphoria, dizziness, fatigue, depression, tremors, sleeplessness, anxiousness, flu-like symptoms, upset stomach, dry mouth, pupil constriction, itching, hallucination, delirium, sweating, muscle and bone pain, confusion, extreme irritability and muscle spasms.

Severe side effects can include severe respiratory depression, confusion or stupor, coma, clammy skin, circulatory collapse and cardiac arrest. Opiates can also cause allergic reactions, some severe. Signs of this include itching, swelling, dizziness, rash and labored breathing. Methods of Misuse Recreational users may take opiates in a manner in which they are not prescribed to achieve a “high” or rush. Most often, this can include chewing, breaking or crushing the drug and taking it orally, snorting it, or injecting it.

Opiate-tolerant patients may take a particular drug more frequently or in higher doses than prescribed to achieve pain relief. Both of these scenarios can lead to severe side effects, dependence, addiction or death. Troubling Trends of Abuse The figure is startling: A 96. 6 percent increase in drug-related deaths in a five-year period (Hanson, 2010). According to Brown University Pharmacology Update (2009), since the period of increases in opioid misuse in the 1990s, data over the last three-to-four years indicate a high, steady prevalence of opioid prescription misuse in the United States.

According to the 2007 National Survey on Drug Use and Health, about 5. 2 million people ages 12 and older were current nonmedical users of prescription pain relievers in 2006, comprising 2. 1% of the population. This rate has remained statistically unchanged since 2002. Survey data from 2002 to 2005 found that 4. 8% of persons ages 12 and older (11. 4 million people) used a prescription pain reliever nonmedically in the 12 months prior to the survey. This data also indicated that an annual average of 57. 7% of people who used prescription pain medication nonmedically in the past year used hydrocodone products, and 21. % used oxycodone products. Recent male users were more likely to use hydrocodone products nonmedically compared to recent female users (61. 4% compared to 54. 9%). Young adults, ages 18 to 25, were more likely than other age groups to have initiated oxycodone products nomedically in the past year (27. 4% for 18-25 year-olds, compared to 20. 3% for 12-17 year olds and 14. 9% for 35-49 year-olds). According to Brown University Psychopharmacology Update (2009), more people ages 12 and older initiated misuse of pain relievers (2. 2 million) than any other illicit substance.

The United States is not the only country that has a problem with opiate abuse. The epidemic spans the entire continent of North America. Dhalla and colleagues report that the number of annual deaths related to oxycodone use in Ontario increased about 5-fold between 1999 and 2004 and that there was a 41% increase in all opioid-related deaths (i. e. , deaths from prescription and illegal opioids). Their paper adds to the evidence showing that the substantial increase in morbidity and mortality from the use of prescription opioids is a major public health challenge in Canada. Fischer, 2009) Experts say drugs containing the active ingredient oxycodone are the source of much of the problem. And the consensus is that an increasing proportion of those coming to methadone treatment have a history of opioid addiction, says Wade Hillier, manager of government programs (independent health facilities and methadone) for the College of Physicians and Surgeons of Ontario (CPSO)(Silversides, 2009). Drug Abuse in Appalachia A greater proportion of people in Appalachia abuse prescription drugs han in the nation as a whole, according to a report released by the federal Appalachian Regional Commission. Appalachia here is defined by the boundaries of the Appalachian Regional Commission, which includes 410 counties in 13 states. Parts of Mississippi are considered Appalachia, as are counties in New York. The ARC boundaries were originally set in 1965 to include a large number of Representatives and Senators. Parts of Kentucky’s Bluegrass Region became Appalachia, as did relatively flat counties in Alabama.

The central portion of Appalachia contains the coal counties of West Virginia, Kentucky, Tennessee and Virginia. The Appalachian Regional Commission ordered the study after years of stories detailing increased prescription drug abuse problems in the region. Proportionately more Appalachian adults abuse prescription drugs than in the nation. An increasing number of Americans across the nation are abusing prescription drugs. That trend is increasing faster in Appalachia than in the rest of the nation, however. Admission rates for the primary abuse of other opiates and synthetics are higher in Appalachia than in the rest of the nation,” according to the report. “Further, while rates are rising both across the nation and in Appalachia, the rate of increase in Appalachia is greater. ” (Bishop, 2008). Opiate Treatment Methadone maintenance programs have been in use for quite some time to control the impact of this addiction on the individual and the community. Methadone is a synthetic opiate that acts as an agonist on the opioid receptors in the brain; that is, it produces an opioid-like effect.

This reduces the desire to use other opioid drugs and prevents withdrawal. However, patients who do not need the methadone program but still need some treatment may benefit from buprenorphine treatment. Buprenorphine monotherapy (Subutex) and buprenorphine/ naloxone combination product (Suboxone) were approved for treatment of opiate addiction by the Food and Drug Administration in 2002. (Bhagar, 2009) Opiates withdrawal, while not being lethal, is the hardest, most painful drug to detox from.

Quitting “cold turkey”, or doing it by oneself, is extremely hard to do because the withdrawal effects are so bad. Most individuals who are dealing with addiction problems seek treatment from a rehabilitation facility. These facilities have many different methods for the rehabilitation process. One of these facilities uses the Waismann Method (Lowenstein, 2007). According to Lowenstein (2007), The Waismann Method of Detoxification Under Anesthesia the most advanced medical techniques available for opiate dependency are utilized.

Patients are treated with the highest level of professionalism, dignity and respect. Safety should be the greatest concern when evaluating and choosing a detoxification treatment. Waismann patients receive intensive observation from admission to discharge, all in a fully accredited medical hospital located in southern California, where they receive patients from all over the world. Pre-Treatment • The Waismann Method sm of Rapid Detox (ANR) begins in a hospital where the patient is admitted a minimum of 24 hours before the procedure and undergoes a comprehensive physical examination. At Waismann a diagnostic evaluations are performed to assess the heart, lungs, liver and kidney functions and other assessments are utilized to identify patients’ deficiencies which may have been a direct or indirect consequence of the dependency. Based on the results of this testing, a personalized detoxification program will be designed to correct imbalances in the brain chemistry, intestinal tract and other medical issues needed for a smooth and safe detoxification. • The duration of both pre-treatment phase and procedure is based on each individual patient’s medical and dependency history.

The goal is to achieve the best results and safety required by their extensive protocol. Specialized physicians (cardiologists, infectious disease specialists, gastroenterologists, pain specialists and others) are available in their hospital to consult patients with complex pre-existing conditions to minimize risks and maximize positive results and comfort. Treatment • Once pre-screening and pre-medication are completed, their Board-Certified Anesthesiologists will perform the Waismann Method SM of Accelerated Neuro-Regulation (ANR) treatment while the patient sleeps comfortably under a light anesthetic in the Intensive Care Unit. Special medications facilitate the cleansing of opiates from the patient’s opiate receptors. • The patient is carefully and closely monitored during the entire procedure. • This medically induced withdrawal is controlled and closely monitored by either Dr. Bernstein or Dr. Lowenstein, both Board Certified Anesthesiologists who are nationally recognized for their leadership and expertise in the use of the Waismann Method and Board Certified specialists in Pain Management. • This accelerated withdrawal syndrome occurs within 1 to 2 hours. Upon awakening, the patient is no longer physically dependent on opiates and has no conscious awareness of experiencing the withdrawal process during the procedure. • They do not use opiate replacement drugs like Suboxone or Methadone substitute for the patient’s drug of dependence and will eventually require patients to undergo withdrawal to remove it. The patients leave opiate free with a full detoxification achieved. • Patients are monitored under their care in the hospital for 1 to 2 days after the procedure to ensure a smooth and safe physical stabilization.

Opiate use causes significant physiological changes and can compromise major organ functions. After detoxification, it is imperative for the patient’s safety and ultimate success that he/she is medically supervised throughout the transition while the body normalizes to being off of opiates. Functions such as blood pressure fluctuation and gastro-intestinal distress can be easily controlled with proper medical attention but can become a threat to the patient’s safety and well being if the patient is alone or with a family member in the hotel room without the proper medical supervision after detoxification. All patients are transferred to Domus Retreat for 1 to 24 days after the hospital stay to continue recovery in a therapeutic and comfortable environment. This is just a glance into one of many forms of addiction. As a society, we must be vigilante as drug use rises. Children are starting to use drugs at a younger age while we as a society sit back and watch. Communities need to be more active and not turn a blind eye to this abuse just because we want to believe it is not there. This is not a war we have to lose, but we must first make a commitment to fight. References Bhagar, H “(Spring 2009).

Prescription primer: buprenorphine mono and combination therapy. Annals of the American Psychotherapy Association, 12, 1. p. 22 (2). Retrieved March 31, 2010, from General OneFile via Gale: http://find. galegroup. com. ezproxy. etsu. edu:2048/gtx/start. do? prodId=ITOF&userGroupName=tel_a_etsul Bishop, B. (2008, August 14). As Poverty Worsens in Appalachia, So Do Drug Abuse and Depression. Daily Yonder. Byrne, M H, Lander, L. , & Ferris, M. (Feb 2009). The changing face of opioid addiction: prescription pain pill dependence and treatment. Health and Social Work, 34, 1. p. 53 (4).

Retrieved March 31, 2010, from General OneFile via Gale: http://find. galegroup. com. ezproxy. etsu. edu:2048/gtx/start. do? prodId=ITOF&userGroupName=tel_a_etsul Fischer, B. , & Rehm, J. (Dec 8, 2009). Deaths related to the use of prescription opioids. CMAJ: Canadian Medical Association Journal, 181, 12. p. 881 (2). Retrieved March 31, 2010, from General OneFile via Gale: http://find. galegroup. com. ezproxy. etsu. edu:2048/gtx/start. do? prodId=ITOF&userGroupName=tel_a_etsul Hanson, K. (March 2010). A pill problem: prescription drug abuse is the fastest growing form of substance abuse. State Legislatures, 36, 3. . 22 (4). Retrieved March 31, 2010, from General OneFile via Gale: http://find. galegroup. com. ezproxy. etsu. edu:2048/gtx/start. do? prodId=ITOF&userGroupName=tel_a_etsul Lanier, W L, & Kharasch, E D (July 2009). Contemporary clinical opioid use: opportunities and challenges. Mayo Clinic Proceedings, 84, 7. p. 572(4). Retrieved March 31, 2010, from General OneFile via Gale: http://find. galegroup. com. ezproxy. etsu. edu:2048/gtx/start. do? prodId=ITOF&userGroupName=tel_a_etsul Ling, W. , & Wesson, D R (May 1990). Drugs of abuse – opiates. The Western Journal of Medicine, 152, n5. p. 565(8). Retrieved March 31,

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